Provider Demographics
NPI:1356819395
Name:PURE BALANCE FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PURE BALANCE FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RESIDENT AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-802-1837
Mailing Address - Street 1:20150 W 219TH TER
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-7800
Mailing Address - Country:US
Mailing Address - Phone:913-802-1837
Mailing Address - Fax:
Practice Address - Street 1:601 N MUR LEN RD STE 5
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-5416
Practice Address - Country:US
Practice Address - Phone:913-538-1582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty